- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.02 / $483.44 / $744.78
| Professional | | $364.02 | $483.44 | $744.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.89 / $590.60 / $1,306.42
| Professional | | $322.89 | $590.60 | $1,306.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.46 / $714.08 / $1,679.80
| Professional | | $543.46 | $714.08 | $1,679.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.96 / $581.02 / $852.64
| Professional | | $327.96 | $581.02 | $852.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.40 / $631.45 / $1,102.08
| Professional | | $464.40 | $631.45 | $1,102.08 |